| NPI | 1457349011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08326800) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD049953L) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2011-10-14 |